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Electrophysiology (EP) Study and Catheter Ablation

Depending on your clinical arrhythmia, or heart rhythm disturbance, and the frequency of the episodes, your physician may refer you for an electrophysiology study (EP) study. These studies are typically performed by heart rhythm specialists in patients with:

  • symptomatic arrhythmias despite medications,
  • intolerable side effects from medications prescribed for their arrhythmia and consequently prefer a curative catheter ablation procedure
  • prefer a curative catheter ablation first-line to avoid medications, or secondary to occupational risks (pilots, public servants – police, fireman, etc)
  • for risk stratification for sudden cardiac death in the presence of structural heart disease or clinically documented arrhythmias  (to determine a need for an ICD)
  • to assess the need for a permanent pacemaker

An EP study is a procedure performed to study the electrical system of your heart. After using sedation and a local anesthetic, your heart rhythm specialist will place several catheters, typically via the groin or neck, into the heart under fluoroscopic, or X-ray, guidance. These catheters are placed in well-defined regions critical to the heart’s normal conduction system, such as the right atrium, His bundle, and the right ventricle. These catheters allow your physician to stimulate your heart and to electrically map the origin and characteristics of your clinical arrhythmia.

Once your arrhythmia is diagnosed in the EP lab, your heart rhythm specialist can elect to proceed with a curative catheter ablation, defer to manage with medications, or recommend that you proceed with an implantable device (pacemaker or defibrillator). An EP study can be performed for diagnostic and/or therapeutic purposes. Many patients have known clinical tachyarrhythmiascaptured on 12-lead EKG or ambulatory monitoring devices and are referred for therapeutic intervention. The therapeutic intervention, or catheter ablation, is typically performed during the same EP study.   By using specialized intracardiac catheters, heat energy can be delivered to the local heart tissue to terminate the tachycardia. The success rates of catheter ablation for supraventricular tachycardias can be greater than 90%.

The risks of an EP study and catheter ablation are small, but, as with any invasive procedure, it is not risk-free. Not all arrhythmias can be cured with catheter ablation and an individually-tailored discussion of your treatment options with your physician is paramount.

Video 2. Technique for cryoablation for atrial fibrillation